MEDICARE: DAVID A. ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	00309	WV

General Provider Information

NPI Number	:	1790961134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID A. ANDERSON

Provider Business Mailing Address
First Line	:	433 MAIN AVE
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-2047
Country	:	US
Telephone Number	:	304-269-3445
Fax Number	:	304-269-5208

Provider Business Practice Location Address
First Line	:	433 MAIN AVE
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-2047
Country	:	US
Telephone Number	:	304-269-3445
Fax Number	:	304-269-5208

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID A ANDERSON
Credential	:
Telephone Number	:	304-269-3445

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	11/17/2022

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Directions to “DAVID A. ANDERSON ” Practice Location

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